Circulation, Vol 81, 20-24, Copyright © 1990 by American Heart Association
RA Josephson, E Shefrin, EG Lakatta, LJ Brant and JL Fleg
An abnormal ST segment response to treadmill exercise has a low predictive
value for future coronary events (angina pectoris, nonfatal myocardial
infarction, or cardiac death) in apparently healthy individuals. To
determine whether the conversion from a normal to an abnormal ST segment
response might identify individuals at high risk for a future coronary
event, we analyzed the results of serial exercise tests performed at
2-4-year intervals in 726 male and female volunteers, aged 22-84 years
(mean, 55.1 years), from the Baltimore Longitudinal Study of Aging (BLSA).
All subjects were free of cardiovascular disease at entry by history,
physical examination, and resting 12-lead electrocardiogram. Over a mean
overall follow-up of 7.4 years, coronary events occurred in 34 of 178
(19.1%) of those with an abnormal ST response to exercise versus 30 of 548
(5.5%) in those with a normal response (p = 0.001). Angina pectoris was the
most common presenting coronary event regardless of ST segment exercise
response. Among individuals with an abnormal ST segment response, the
incidence of events was virtually identical between those with an initially
abnormal response (group 1) and those who converted from a normal to an
abnormal response (group 2), 19.8% versus 18.5%. After adjustment for
standard coronary risk factors by proportional hazards regression analysis,
the risk of a coronary event relative to subjects with persistently normal
ST segment responses (group 3) remained nearly identical in the two groups,
2.72 in group 1 (p less than 0.003) and 2.80 in group 2 (p less than
0.002).(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Can serial exercise testing improve the prediction of coronary events in asymptomatic individuals?
Gerontology Research Center, NIA, Baltimore, Maryland 21224.
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